value-based healthcare

VIP access: a proposal for a new model for embracing healthcare innovation

Access
15 Mar 2021
High-value innovations in care delivery play an essential role in solving the challenges facing Europe’s health system. However, ensuring adoption and uptake of new technology solutions is far from simple. Current reimbursement and access models have served Europe well but are now reaching their limit in ensuring timely patient access to truly cutting-edge technologies and services. Therefore, it is time for innovative approaches to better integrate innovation into existing health systems. To that end, a new Value of Innovation and Partnership access model (or VIP for short) is proposed. Innovative models Let’s look at how access works today. The current approach has three main elements: regulatory approval, reimbursement and procurement. The problem is that some really innovative technological advances do not always fit neatly into existing reimbursement pathways. They may have high potential value but require additional investment or structural changes in how care is delivered. My new opinion paper, ‘Access to Medical Technology Innovations: A Proposal for a Value of Innovation and Partnership Model’ , sets out in more detail the shortcomings of the current access model. Any new model needs to find ways to reward high-value medical technology innovations; provide timely access to these innovations; and ensure that health systems are sustainable. The proposed VIP model aims to do this in a spirit of partnership between healthcare providers and innovators. It has two phases: 1) The research & innovation phase: testing and assessing safety, clinical performance and claimed benefit 2a) The health system accessibility phase: special innovation access programmes to address unanswered questions 2b) The routine usage phase: adoption of a new technology, along with reimbursement or a new finance scheme Accelerated Coverage Pathways for Innovation For most technologies, phase 1 and 2b are sufficient as they will fit into existing reimbursement systems. However, phase 2a applies to...

How innovative procurement can improve healthcare outcomes

Value Based Procurement
2 Dec 2019
In healthcare, the traditional role of procurement was to secure the availability of goods and services needed to deliver care. Once this was achieved, procurement moved one step up the ‘pyramid of procurement activities’: negotiating on product prices and discounts, in order to reduce spending on medical devices and consumables. In recent years, things have moved on. Procurers have engaged with internal multi-stakeholder interests when tendering for new contracts. This has helped to make procurement, in itself, an important business function. Looking back at how things have evolved, I think we have already come a long way. In fact, it has been quite some time now since purchasing decisions for medical devices were made only by doctors. These days, healthcare institutions cooperate at national level in the area of procurement in order to achieve greater efficiency (distribution of activities) and effectiveness (bundling of purchasing volumes and obtaining better purchasing conditions). We have even seen the first examples of cross-border cooperation: German Group Purchasing Organisations (GPOs) entering the Dutch market; EHPPA, a partnership of several European GPOs; and private clinics organising their procurement activities from a central hub, to name just a few. Despite this dramatic change for the better, I believe the ultimate objective for procurement (‘the top of the pyramid’) should be to take a strategic role: contributing to patient-centric, sustainable healthcare across Europe. However, when pooling of activities, knowledge and volume is narrowly applied only to lowering product prices, procurement misses out on achieving its full potential. Procurement cooperation offers a unique opportunity to adopt innovative procurement approaches much faster and with greater impact compared to single healthcare providers. Furthermore, by including (patient) outcome criteria in tenders, procurement can have a major impact on both the improvement of healthcare outcomes and the total cost of delivery – not...

Why healthcare needs ‘innovation in delivery’

Value
4 Jun 2019
In European countries, we have seen a rise in real health expenditure that is greater than real growth in national incomes. But, despite this, improvement s in health outcomes have been subdued. More is going in but less is coming out of health systems. To me, the key question is not only Why has this happened? It is also important to ask how we reverse the trend to achieve much better outcomes while achieving improved efficiency in health systems of Europe. We know that there are high levels of inefficiency and waste in European health systems. But there is hope: the best performing EU countries have managed to improve efficiency levels while increasing life expectancy and reducing levels of premature death. I believe innovation is the key to solving this problem. However, we are faced with a paradox between the 'delivery of innovations' and 'innovation in delivery'. The 'delivery of innovations' has been remarkable, thanks to breakthroughs in science and the digital revolution. Medical devices, medicines and health technologies are enabling more precise diagnosis, monitoring and treatment. At the same time, 'innovation in delivery' of healthcare services has been all but stagnant. This is a source of inefficiency; a failure to improve the effectiveness, equity and responsiveness of health care required to achieve better and more consistent outcomes. And so, while the world around us changes, healthcare is a laggard in terms of how it delivers services. Entertainment, communication, banking and government services have responded to technological advances to rethink how they meet the needs of citizens and consumers. We cannot afford this any longer. New funding and investment models are critically needed for transformative innovations in health systems to achieve value, ensure sustainability and protect universal health coverage enjoyed by citizens of Europe. A sustainable model By incorporating value...

The EU’s future public-private partnership for health marks a new era for medtech innovation

Research & Innovation
26 Apr 2019
As European research and innovation funds extend their focus towards diagnostics, digital and medical technologies, medtech companies must be ready to engage. A major future EU public-private partnership in research and innovation is currently in gestation. I believe it could help to address some of the biggest challenges in modern healthcare – and its scope will be wide enough to welcome medical devices and diagnostics companies, large and small. Let’s consider some historical context. The EU research and innovation budget is significant. The Horizon 2020 programme, which ends next year, has a budget of around €80 billion. One of the key elements, as far as healthcare is concerns, has been the Innovative Medicines Initiative (IMI). This public-private partnership was funded by the European Commission and through in-kind contributions from pharmaceutical companies. In its first iteration, it had a total budget of €2 billion. The current incarnation which ends next year, has a budget of more than €3 billion. While IMI has, for more than 10 years, fostered collaboration and cooperation between pharmaceutical companies in unblocking bottlenecks in the medicines development pipeline, I expect the next big ‘PPP Health’ to go further. Modelled on the IMI structure as well as the ECSEL partnership for the micro-electronics sector, it will encompass pharma, biotech and medtech. This makes perfect sense: the solutions to the health challenges we face as a society do not lie in one industry – the future is patient-centred and integrated, with a significant role for digital technologies. I expect this approach to be welcomed by the medtech sector, particularly if it is accompanied by supports that will help start-ups and entrepreneurs tap into funds that may previously have seemed distant or complex. After all, it is from these dynamic but smaller players that innovation flows. The reality is that...